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M10.9 ICD-10-CM Code: Gout, unspecified

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 1 Excludes2 · 7 use-additional codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 553 — BONE DISEASES AND ARTHROPATHIES WITH MCC (MDC 08)
  • MS-DRG 554 — BONE DISEASES AND ARTHROPATHIES WITHOUT MCC (MDC 08)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for M10.9 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on M10.9 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Gout NOS

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from M10

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify:
  • Autonomic neuropathy in diseases classified elsewhere (G99.0)
  • Calculus of urinary tract in diseases classified elsewhere (N22)
  • Cardiomyopathy in diseases classified elsewhere (I43)
  • Disorders of external ear in diseases classified elsewhere (H61.1-, H62.8-)
  • Disorders of iris and ciliary body in diseases classified elsewhere (H22)
  • Glomerular disorders in diseases classified elsewhere (N08)

Source: inherited from M10

Coder workflow for M10.9

MedCoder structured workflow — derived from this code’s own official record

Before you code M10.9

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, M10.9 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewM10.4

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — M10.9 is appropriate when the documentation goes no further.

    ReviewM10.4

Consider M10.9. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of M10.9(1 note)

    Coding workflow: The conditions named in this note are not included in M10.9. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareM1A

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying M10.9(7 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with M10.9 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewG99.0, N22, I43, H61.1, H62.8, H22

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewM10.4

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with M10.9?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewG99.0, N22, I43, H61.1, H62.8, H22

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Gout, unspecified is a billable ICD-10-CM diagnosis code (M10.9).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (4)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name M10.9 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 3 Excludes1 notes across 2 chapters: E72 — Other disorders of amino-acid metabolism (via M10.-), E79 — Disorders of purine and pyrimidine metabolism (via M10.-), M1A — Chronic gout (via M10.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: M1A — Chronic gout (via M10.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 5 Code First instructions across 4 chapters: G99.0 — Autonomic neuropathy in diseases classified elsewhere (via M10.-), H22 — Disorders of iris and ciliary body in diseases classified elsewhere (via M10.-), H62.8 — Other disorders of external ear in diseases classified elsewhere (via M10.-), N08 — Glomerular disorders in diseases classified elsewhere (via M10.-), N22 — Calculus of urinary tract in diseases classified elsewhere (via M10.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 553 (MDC 08), DRG 554 (MDC 08).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MUS033 — Gout (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Gout).

+362 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Neuritis”; these codes share that main term but sit in a different category of the Tabular List.

G57.9 — Unspecified mononeuropathy of lower limb (ilioinguinal), G58.8 — Other specified mononeuropathies (specified nerve NEC), G60.0 — Hereditary motor and sensory neuropathy (Déjérine-Sottas), G61.0 — Guillain-Barre syndrome (infectious NEC), G62.1 — Alcoholic polyneuropathy (alcoholic), G62.2 — Polyneuropathy due to other toxic agents (toxic NEC), G62.9 — Polyneuropathy, unspecified (peripheral), H46.1 — Retrobulbar neuritis (optic, retrobulbar), H46.2 — Nutritional optic neuropathy (optic, nutritional), H46.3 — Toxic optic neuropathy (optic, toxic), H46.8 — Other optic neuritis (optic, specified type NEC), H46.9 — Unspecified optic neuritis (optic), H93.3 — Disorders of acoustic nerve (acoustic), M51.9 — Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder (due to, herniation, nucleus pulposus), M54.14 — Radiculopathy, thoracic region (thoracic), M54.16 — Radiculopathy, lumbar region (lumbar), M54.17 — Radiculopathy, lumbosacral region (lumbosacral), M79.2 — Neuralgia and neuritis, unspecified, P11.3 — Birth injury to facial nerve (facial, newborn), T80.69 — Other serum reaction due to other serum (serum), +26 more

Contextual Map

Every relationship of M10.9 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run M10.9 with these 8 related codes in Claim Check

Hierarchy

Index manifestation

Referenced by Excludes1 notes

Referenced by Excludes2 notes

  • M1A — Chronic gout[Excludes2](via M10.-): “acute gout (M10.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code First instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 08 — Diseases and Disorders of the Musculoskeletal System and Connective Tissue[MDC crossing]: “Diseases and Disorders of the Musculoskeletal System and Connective Tissue — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 18,508 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Gout, gouty (acute) (attack) (flare)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Iritis, gouty[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Neuritis (rheumatoid), gouty[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Podagra[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "M10.9 — Gout, unspecified." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/m10.9-gout-unspecified

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Gout, unspecified

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to M10.9 in its code family, with their registry titles.

View all codes in the M10 family